In recent years, enforcement of US labor regulations has been on the decline, child labor violations number in the hundreds of thousands annually, and little progress has been made in reducing the number of young worker occupational fatalities. Evidence shows that non-fatal injuries can occur when youth are illegally employed yet little research has looked at the relationship between fatal young worker injuries and labor and safety violations. Understanding this problem and generating strategies for improvements are the goals of this study and are ones that address the National Occupational Research Agenda's (NORA) longstanding focus on traumatic injury and young workers as a special population at risk. To achieve this goal, the study will take an innovative mixed-methods approach that involves taking the findings into the field and engaging with local stakeholders (i.e., enforcement and public health officials) to affect change at the local level an approach that contributes to the Research-to-Practice initiative of the National Institute for Occupational Safety and Health. The first aim of the study is to understand the extent to which violations of child labor laws and/or health and safety standards are related to adolescent occupational fatalities by capitalizing on the excellent data available within the North Carolina medical examiner system - one of the nation's best - consisting of 400 examiners who carry out thorough investigations of fatalities and report these findings to the Office of the Chief Medical Examiner where investigation data are housed. The second aim is to explore how the current enforcement environment might have an impact on this relationship by examining the extent and nature of investigations carried out by federal and NC regulatory agencies on identified young worker fatalities. These data are public record and available from the respective authorities upon request. The last aim is to identify current challenges in enforcement and develop strategies to overcome these challenges and improve the protection of young workers by engaging with a range of local stakeholders through focus groups, in-depth interviews, and a multi-organizational capstone meeting. This study will advance the depth of our understanding of the most serious occupational injuries, fatalities, extending earlier research on young workers in NC and adding an innovative component - the use of participatory methods to share our findings and engage with stakeholders to develop prevention strategies. This work addresses the NIOSH strategic goal to promote safe and healthy workplaces through interventions, recommendations and capacity building and NORA's call for collaboration among multiple professional disciplines, industries, agencies, and groups, which it recognizes as being essential to the development and implementation of prevention strategies to reduce occupational injuries. Based in NC, this study has relevance to other jurisdictions facing similar challenges in reducing fatal and non-fatal injuries among our youngest and highly vulnerable workers. This research advances the depth of our understanding of the most serious occupational injuries, fatalities, which occur among adolescents at a rate of more than one every week in the US. This project will investigate the relationship between adolescent occupational fatalities and violations of labor and safety regulations. It will then use these findings to inform and engage local stakeholders to improve enforcement and compliance with regulations in order to better protect the health and lives of young workers.